Extension of mammographic screening to the over 70s: a study of patient and health care professional opinion

Abstract

Introduction: Women over 70 have low self referral rates for breast screening and most are unaware of screening availability. Screening women aged > 70 is less effective compared to younger women, but benefit is gained in fitter older women. Methods: 1. 26 women aged >70 and 18 health care professionals (HCPs), were interviewed about breast screening in older women. Framework analysis was used to identify themes. 2. A questionnaire was sent to 460 HCPs to determine factors affecting decision making about breast screening. Individual case scenarios were presented for respondents to determine whom they felt might benefit from continued screening (conjoint analysis). Results: Interviews: Women over 70 were unaware that screening was available; most felt that screening was beneficial and that women should not be denied a mammogram on the basis of age. Most felt that the current system could be improved to enhance uptake. Most HCPs cited lack of patient awareness as a problem and stated that screening should be available to those who are fit enough to benefit. Questionnaire: The response rate was 123/460 (27%). Key factors in deciding to advise screening were: life expectancy, functional status and age. Patient scenarios demonstrated the strongest deterrents for screening were dementia and age >85. HCPs recommended women with a predicted life expectancy of > 5 years for screening. Conclusions: Older women and HCPs are in favour of screening extension beyond its current limits. The current system is flawed because older women are unaware of screening availability. Patient education is urgently required.